Subcision for Acne Scarring New York City
Acne scarring can range in severity from just a few scars to scars that cover the entire face. There are several options to lessen the appearance of acne scars, depending on the extent of the scarring.
Dr. Yang traditionally performs subcision to reduce the appearance of depressed acne scars, or acne scars that create an uneven skin surface. This method of scar reduction breaks down the fibrous tissue that secures damaged skin to its underlying tissue. Freeing the skin from the tissue underneath creates a smoother and more even complexion.
The Subcision Technique (Traditional Subcision)
In Dr. Yang’s experience, regular subcision works best with rolling acne scars. Rolling acne scars have normal skin over the rolling scar, but have fat loss due to cystic acne that burst and caused fat loss under the skin. The traditional subcision technique works best with rolling acne scares because the tissue loss is under the skin within the subcutaneous fat, and the collagen build up from the blood clot is in the subcutaneous layer.
Many patients can undergo the procedure on the date of their first consultation with Dr. Yang. After discussing the procedure with his patient, Dr. Yang applies a topical numbing gel to reduce any discomfort associated with injecting the local anesthetic. After injecting local anesthesia, Dr. Yang uses a hypodermic needle to puncture the skin and undermine the outer layer of skin, thereby releasing it from the facial tissue. Using a back and forth motion, Dr. Yang is able to break the fibrous tissues causing the indentation. The procedure takes no longer than 15-20 minutes and has minimal discomfort associated with it. There is about a week of recovery time with patients experiencing bruising, swelling, and redness for a several days following the procedure.
The more bruising the patient experiences, the better this procedure seems to work. If there is too little bruising, the improvement is less. Why? After the scarred area is untethered, the skin needs to pop up. However, without a “spacer” of filler, fat, or a blood clot, the untethered skin can simply heal back into the depression. The result is less visible improvement compared with a subcised area where sufficient bruising and bleeding resulted in a large enough blood clot to keep the skin untethered.
Dr. Yang has found that although the response to subcision varies from patient to patient, generally if the subcised area is very small (about the size of a hole punch), the blood clot may not be large enough to prevent the untethered skin from healing back into the depression. Results are best when the subcised area is at least quarter-sized because the blood clot formed under the skin is large enough to withstand breakdown by the body. The residual blood clot begins as disorganized collagen, but as it continues to remodel itself, the collagen becomes more organized. This new collagen is long lasting.
Subcision with Fillers
Injecting acne scars with fillers can be a very satisfying procedure with relatively minimal downtime. However, because acne scars may tether down the skin, some of these indented scars can not be smoothed out with filler alone. Because the center portion of the indented acne scar is tethered down with collagen fibers, the filler tends to extrude around the tethered area to create a “doughnut effect.” In other words, the indentation barely improves, and the edges of the acne scar become filled and rise up higher, worsening the overall appearance.
In these cases, some subcision is helpful in untethering the collagen fibers to allow the filler to lift up the central portion of the indented scar. Without subcision, the filler does not have enough “hydraulic” pressure to push out the indentation. Typically Dr. Yang will attempt to conservatively fill the indented acne scars, and if the scar does not lift easily, Dr. Yang will perform some light subcision with the same small needle used to inject the filler to release the collagen fibers before adding more filler. This helps avoid the “doughnut effect.”
Because the subcised area is much smaller and a smaller needle is used, the amount of bruising is greatly reduced. Furthermore, the filler that is pushing out the indentation also acts to compress the subcised area. This effectively reduces the amount of bleeding and subsequent bruising compared to a traditional subcision. This technique allows patients to experience the benefits of subcision with relatively little recovery time.